CORONAVIRUS (COVID-19)
(updated 1/2/2022)
​Please go to the end of this page for information regarding COVID-19 vaccine and booster and check back as needed for updates

If you are sick, please stay home. 

We require all staff, patients and visitors to wear a mask that covers the mouth and nose. Masks with valves are NOT allowed since they do not prevent the transmission of virus.

We request that for your appointment, you come alone unless assistance is required for translation, you are unable to manage walking by yourself, or have issues with your memory/comprehension.  This precaution is to limit exposure to the visitors, other patients and staff.  If a driver is necessary, we request that they wait outside or in the waiting room.  We hope you understand that we are trying to limit the spread of COVID-19 in any way possible. 
 
Our current guidelines are to continue all the medications prescribed to you by our office including prednisone, biologic therapy, and all DMARD therapy.  However, if you have been exposed to someone who has tested positive for COVID-19 or is undergoing testing for COVID-19, hold biologic therapy/targeted DMARD therapy for 2 weeks (except you may continue Actemra and Kevzara). If you remain symptom free (with no fevers, chills, cough, or shortness or breath), you may resume your biologic therapy. 

​If you have any signs/symptoms of coronavirus such as fever, cough, shortness of breath, loss of smell/taste, we ask that you call your family doctor’s office for guidance regarding testing and treatment for coronavirus.  Continue your Hydroxychloroquine/Chloroquine.  Stop Methotrexate, Leflunomide, Azathioprine, Sulfasalazine.  If you are on steroids (prednisone, methylprednisolone), please call our office for directions.  Steroids should never be stopped abruptly.  Stop targeted DMARD/biologic therapy (Remicade, Humira, Enbrel, Simponi, Cimzia, Orencia, Xeljanz, Olumiant, Rinvoq, Rituxan, Benlysta, Cosentyx, Taltz, Stelara, Tremfya) just as you would hold these medications for any other illness.  However, if you are on Actemra or Kevzara, please call our office for further directions regarding their continued use.
 
If you have a fever, avoid taking lNSAIDs (Ibuprofen, Aleve meloxicam etc).  You may take Tylenol for a fever.  If you already take an NSAID regularly, you may continue to take it as long as you do not have severe respiratory symptoms. 

We understand that with a new disease like COVID-19, recommendations change with time based on new information that is collected.
The current recommendations from the American College of Rheumatology released in 05/2020 report that the "risk of poor outcomes from COVID-19 appear to be related primarily to general risk factors such as age and co-morbidities" (diabetes, heart disease, lung disease, obesity) rather than rheumatic diseases or the use of immunosuppressive therapy.  However, there is a higher risk of hospitalization in rheumatology patients taking prednisone 10mg/day or higher but not with the use of NSAIDs, DMARDs, biologic drugs, JAK inhibitors.
The primary focus is still to avoid getting COVID-19 with practicing social distancing, frequent hand washing.

Based on this information, we are unable to provide a letter specific to your disease or treatment but recommend you discuss it with your employer regarding ways to maintain social distancing per CDC guidelines.

PER CDC update on 12/27/2021Given what we currently know about COVID-19 and the Omicron variant, CDC is shortening the recommended time for isolation for the public. People with COVID-19 should isolate for 5 days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by 5 days of wearing a mask when around others to minimize the risk of infecting people they encounter. The change is motivated by science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.
Additionally, CDC is updating the recommended quarantine period for anyone in the general public who is exposed to COVID-19. For people who are unvaccinated or are more than six months out from their second mRNA dose (or more than 2 months after the J&J vaccine) and not yet boosted, CDC now recommends quarantine for 5 days followed by strict mask use for an additional 5 days. Alternatively, if a 5-day quarantine is not feasible, it is imperative that an exposed person wear a well-fitting mask at all times when around others for 10 days after exposure. Individuals who have received their booster shot do not need to quarantine following an exposure, but should wear a mask for 10 days after the exposure.  For all those exposed, best practice would also include a test for SARS-CoV-2 at day 5 after exposure. If symptoms occur, individuals should immediately quarantine until a negative test confirms symptoms are not attributable to COVID-19.


All the currently available vaccines in the US - Pfizer/BioNTech (FDA approved 8/23/2021), Moderna and Johnson and Johnson (received emergency use authorization by the FDA) are not live vaccines.  
The American College of Rheumatology released guidelines (not rules) for the COVID-19 vaccine in patients with rheumatic illness:

EVERYONE SHOULD GET THE VACCINE (prefer mRNA vaccine)
  • No modifications to either immunomodulatory therapy or vaccination timing with the primary vaccine series
    • Hydroxychloroquine (Plaquenil); IVIG; glucocorticoids (steroids), prednisone <20mg/day
    • Sulfasalazine; Leflunomide (Arava); Azathioprine (Imuran); oral Cyclophosphamide (Cytoxan);
    • TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); IL-6R (Actemra, Kevzara); IL-1 (Anakinra, Kineret); IL-17 (Cosentyx, Taltz); IL-12/23 (Stelara); IL-23 (Tremfya); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin)
  • HOLD Therapy (only if your disease is well controlled - you have not used higher dose prednisone for at least one month; please check with your rheumatologist if you are uncertain about your disease control) 
    • Methotrexate (MTX): Hold MTX one dose after each vaccine dose or on the day of the vaccine if your MTX happens to be on the same day as the vaccine; if you receive a single dose vaccine, hold MTX for 2 doses after the vaccine
    • Cellcept (mycophenolate): Hold for one week after each dose of vaccine
    • JAK Inhibitor (Xeljanz, Rinvoq, Olumiant): Hold JAKi for 1 week after each vaccine dose
    • Abatacept (Orencia): Hold SQ abatacept both one week prior to and one week after the first COVID-19 vaccine dose (only); no interruption around the second vaccine dose
      • IV ABA (Orencia): Time vaccine administration so that the first vaccination will occur four weeks after abatacept infusion (i.e., the entire dosing interval), and postpone the subsequent abatacept infusion by one week (i.e., a 5-week gap in total); no medication adjustment for the second vaccine dose
    • Rituximab (Rituxan): Schedule vaccination so that the vaccine series is initiated approximately 4 weeks prior to next scheduled rituximab cycle; after vaccination, delay Rituxan 2-4 weeks after 2nd vaccine dose, if disease activity allows
    • IV Cyclophosphamide (Cytoxan, CYC): Time CYC infusion one week after each vaccine dose, when feasible

COVID VACCINE BOOSTER/3rd dose
Guidelines released on 8/13/2021 by the CDC/ACIP recommend that any patient on immunocompromising medicines should receive a 3rd dose of COVID-19 vaccine if the original vaccine was an mRNA vaccine (Pfizer-BioNTech or Moderna) and the 2nd dose of the primary vaccine series was over 28 days prior or the original vaccine was Johnson and Johnson and the dose was over 2 months prior 
  • No antibody testing is recommended after any COVID-19 vaccine or COVID infection to assess response to vaccine or need for booster dose​
  • You may get any of the approved vaccines as your 3rd dose (if mRNA vaccine was the primary series) or 2nd dose (if J&J was the primary vaccine)
  • You should get the 3rd dose (includes full dose of Moderna) if were are on any of the following medications with the primary vaccine series – Methotrexate, Leflunomide, Sulfasalazine, Azathioprine, Cellcept/Mycophenolate, Cytoxan, Orencia/Abatacept, JAK inhibitors (Xeljanz, Olumiant, Rinvoq), TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); IL-6R (Actemra, Kevzara); IL-1 (Anakinra, Kineret); IL-17 (Cosentyx, Taltz); IL-12/23 (Stelara); IL-23 (Tremfya); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin); Ilaris
  • If your rheumatic disease is well controlled, please hold these RA medications for 1-2 weeks after the booster dose (Methotrexate, Leflunomide, Sulfasalazine, Azathioprine, Cellcept/Mycophenolate, Orencia/Abatacept, JAK inhibitors (Xeljanz, Olumiant, Rinvoq), TNFi (Enbrel, Humira, Remicade, Simponi, Cimzia); Belimumab (Benlysta); oral calcineurin inhibitors (cyclosporin, Voclosporin))​
  • If you are on Rituxan infusions, please call the office so we may advise you on the timing of the vaccine
  • If you are on prednisone on a daily basis, please call the office for directions. If you take prednisone as needed, please avoid taking prednisone for at least 2 weeks after the vaccine.
  • If your rheumatic disease is not well controlled, please call the office BEFORE you stop your medications
CDC also strongly recommends:
  • Wearing a mask
  • Staying 6 feet apart from those they don’t live with
  • Avoiding crowds and poorly ventilated indoor spaces until advised otherwise by their healthcare provider
  • Close contacts of immunocompromised people are strongly encouraged to be vaccinated against COVID-19



BOOSTER SHOT (includes 1/2 dose of Moderna vaccine)
  • CDC recommends that everyone should receive a booster shot of COVID-19 Vaccine at least 6 months after completing their mRNA primary series (i.e., the first 2 doses of a COVID-19 vaccine) or 2 months after J&J vaccine

If you are exposed to COVID-19 2 weeks after you have been vaccinated, you should get tested 5 days after exposure and maintain all other precautions w.r.t. masking and social distancing until test results are known. If you test positive or have symptoms suggestive of COVID-19, then you should quarantine for 5 days from symptoms onset (10 days if not vaccinated). 

You may receive the COVID-19 booster dose and flu shot on the same day

Here is a link to more information about vaccines against COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html

https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/covid-19-faqs-medication-treatment-and-vaccines

https://www.nejm.org/covid-vaccine/faq

We ask that you follow the guidelines suggested by CDC and please review the following website for additional up to date information.
www.coronavirus.gov​